University of Toronto Student Leadership Award Nomination Form Page 1 of 7
UNIVERSITY OF TORONTO STUDENT LEADERSHIP AWARD
NOMINATION FORM
This nomination form contains several text boxes with character limits; these are noted as such within the form.
You may find it helpful to use a tool such as www.charactercountonline.com
SECTION A: NOMINEE INFORMATION – TO BE COMPLETED BY STUDENT
PERSONAL INFORMATION
First Name Last Name
Name on Certificate (Student name exactly as it should appear on award certificate)
Phone Number Email Address Student Number
College/Faculty/School Expected Graduation Date
(Month, Year)
List any other/previous U of T college or faculty affiliations and graduation years, if applicable:
Nominee is currently a graduate student:
ƛ
Yes
ƛ
No
If yes, please specify the affiliated graduate department:
University of Toronto Student Leadership Award Nomination Form Page 2 of 7
SECTION A: NOMINEE INFORMATION (CONTINUED)
VOLUNTEER LEADERSHIP AND SERVICE POSITIONS
In the box below, list your volunteer leadership and service roles and activities. List only U of T-related roles. Do not list paid roles.
External volunteer roles should not be included unless they are required to provide context for U of T roles listed.
List information chronologically, briefly summarize the role and clearly demonstrate the impact of your contributions.
The following is an example of the information required:
Date
(Start/End)
Role Full name of committee/
volunteer initiative
(include faculty/college, division)
Brief description of role,
including a summary of impact
Jan 2017
Present
President, Outreach Committee Ping Pong Club,
Hart House
Planned and executed student-related e-communications to Ping
Pong Club members. Created and sent 35 newsletters over three
years, engaging 310 members.
Sep 2014
Jun 2017
Co-President U of T International
Relations Society
Chaired monthly meetings and represented over 400general
members of the program. Organized and hosted five events
and forums with guest panels.
Date
(Start/End)
Role Full name of committee
volunteer initiative
(include faculty/college, division)
Brief description of role,
including a summary of impact
University of Toronto Student Leadership Award Nomination Form Page 3 of 7
SECTION A: NOMINEE INFORMATION (CONTINUED)
Date
(Start/End)
Role Full name of committee/
volunteer initiative
(include faculty/college, division)
Brief description of role,
including a summary of impact
University of Toronto Student Leadership Award Nomination Form Page 4 of 7
SECTION A: NOMINEE INFORMATION (CONTINUED)
AWARDS AND HONOURS (OPTIONAL)
List any awards and honours you have received during your time as a university student.
List information chronologically.
Award/Honour Year
Received
Brief Description
OTHER ACHIEVEMENTS (OPTIONAL)
List any additional relevant achievements or accomplishments that you would like to share with the Student Leadership Award Selection
Committee.
(Character limit: 1,000)
University of Toronto Student Leadership Award Nomination Form Page 5 of 7
SECTION A: NOMINEE INFORMATION (CONTINUED)
PERSONAL STATEMENT
In 150 words or less, describe the various ways in which your leadership has directly contributed to building or enhancing the U of T
community. Clearly demonstrate the impact of these contributions in relation to your college, faculty, program, or the University at large.
(Character limit: 1,000)
SUMMARY CITATION
Using one or two sentences (30 words or less), describe the contribution of which you are most proud. If the committee selects
you as a Student Leadership Award recipient, the information you provide here will be used as the basis for any citation that may
be required by your division. Note that you should write this section in the third person.
(Character limit: 200)
NOTE: Students must complete all mandatory confirmations in Section C of this nomination form prior to submission.
University of Toronto Student Leadership Award Nomination Form Page 6 of 7
SECTION B: NOMINATOR INFORMATION AND ENDORSEMENT
Role:
ƛ
Faculty
ƛ
Staff
ƛ
Alumni
Name Email Address
Title Phone Number
College/Faculty/School
Relationship to Nominee
Describe the individual’s volunteer contributions to their college, faculty or to the University.
Ensure you:
highlight leadership and service roles
demonstrate the resulting impact or significance of these achievements to the relevant community
(Character limit: 2,500)
University of Toronto Student Leadership Award Nomination Form Page 7 of 7
SECTION C: MANDATORY TO BE COMPLETED BY STUDENT
CONFIRMATION OF CGPA
To be eligible as a Student Leadership Award nominee, you must have a minimum CGPA of 2.70 (B−) at the end of the previous
academic session.
I, the nominee, confirm that I meet the minimum CGPA requirement of 2.70 and I authorize verification of my CGPA in ACORN.
TO BE COMPLETED BY STUDENT
Mandatory confirmation:
ƛ
Yes
ƛ
No
I, the nominee, confirm that this is my only submission. I understand multiple submissions are not permitted.
TO BE COMPLETED BY STUDENT
Mandatory confirmation:
ƛ
Yes
COLLECTION AND USE OF NOMINATION INFORMATION
It is the nominator’s responsibility to ensure that the nominee has been informed of the nomination and the privacy statement
below. Nominees must provide consent by checking the box below. Consent is required for the nomination package to be considered
complete and to be accepted.
The University respects your privacy. The information gathered here is collected and used for the administration of the Universitys advancement
and administrative activities (including: the dissemination of news about the University and the alumni community; fundraising; and communication
of information about student and/or alumni programming including, events, benefits and services) pursuant to the University of Toronto Act 1971.
This information may be shared between the divisions of Student Life and University Advancement. At all times it will be protected in accordance
with the Freedom of Information and Protection of Privacy Act.
TO BE COMPLETED BY STUDENT
Mandatory consent:
ƛ
Yes
If you have questions about the privacy act, please refer to www.utoronto.ca/privacy
SECTION D: MANDATORY TO BE COMPLETED BY DIVISIONAL NOMINATION COORDINATOR
Name of Nomination Coordinator Division
Student is nominated for contributions to:
ƛ
Division
ƛ
University-wide
CONFIRMATION OF STUDENT INFORMATION ON PAGE 1 OF THIS NOMINATION FORM
I, the Nomination Coordinator, confirm that the nominee’s name as it appears in the “Name on Certificate” box is accurate
and has been confirmed with the nominee.
Mandatory Confirmation:
ƛ
Yes
I, the Nomination Coordinator, confirm that the nominee meets the minimum CGPA requirement of 2.70, as verified by ROSI.
NOTE: If “NO” is checked below, the coordinator must provide verification from the division’s registrar formally acknowledging
that extenuating circumstances have resulted in the student’s CGPA being below the academic threshold for this award.
Students who do not meet the CGPA requirement and who do not have verification from their registrar will automatically
be ineligible for this award.
Mandatory Confirmation:
ƛ
Yes
ƛ
No
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